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This blog post is to help you prepare for the ‘what if’ scenario if you need an assisted delivery for the birth of your baby.

An assisted delivery means when a doctor uses an instrument such as forceps or ventouse cup (sometimes called a Kiwi cup) to deliver your baby’s head. Around one in eight women deliver their baby in this way in the UK. This can be because

there are concerns about the baby’s heart rate

your baby is in an awkward position

you’re too exhausted and have been pushing for a long time

A forceps consists of two smooth metal long ‘salad spoon’ type instruments which are curved to shape around the sides of your baby’s head.

These are fitted carefully by the doctor and the handles of the forceps are then locked together securely. As you get a contraction the doctor will gently pull down onto the forceps as you push to guide your baby’s head to entrance of your vagina. When your baby’s head begins to crown and stretch your perineum the doctor may make a cut called an episiotomy to make the space in your vagina and perineum to allow for the baby’s head to be born. Once to the head is delivered the doctor will remove the forceps from around your baby’s head and wait for another contraction to deliver the shoulders and rest of your baby.

THINGS TO CONSIDER WHEN HAVING A FORCEPS DELIVERY:

you are more likely to have an episiotomy which will require stitches which are done by the doctor (these are disolveable.)

if you don’t have an epidural, local anaesthetic will be injected into the area before the doctor makes the cut so you not feel it

you are more likely to bleed from the ‘cut’ (episiotomy) therefore your overall blood loss will be more

if after 3 pulls the baby cannot be delivered in this way the delivery should be abandoned and a caesarean section should be considered

therefore most forceps deliveries happen in theatre for this reason

you should still be able to have skin to skin with your baby

your can still have delayed cord clamping

your birth partner can cut the cord

you will require a catheter to be inserted into your urethra to empty your bladder of urine which usually stays in for 12 hours following the birth of your baby

you have an increase chance of having short term incontinence problems such as not be able to control your wind or bowel movements

you may feel more internal and external bruising from the forceps delivery than a ‘natural’ delivery

you may therefore need stronger pain relief after the delivery to make you more comfortable especially when sitting to feed your baby or going to the toilet

your baby is likely to be born with some markings on its face such as bruising on the side of the forehead and circular red marks around the cheeks. These should go after 24-48 hours

due to bruising around your baby’ jaw and mouth they can find breastfeeding more difficult and you both may require extra support. Some women choose to use a Cranial Osteopath once discharged from hospital

A ventouse delivery (or kiwi cup) is when a doctor applies a small silicone cup to the top of your baby’s head inside your vagina. Once the cup is in place, the air is sucked out of it using a foot-controlled vacuum pump, or a hand-held pump.

It can be noisy if a machine is used, so be prepared. When it is securely fixed, the doctor will ask you to push with your next contraction. The doctor will pull on the cup to help your baby out. Sometimes the cup comes off the baby’s head, which even if it sounds alarming, won’t cause any harm to your baby. After 3 pulls the baby’s head should begin to crown and stretch the perineum. Unlike a forceps birth where more space is require, with a ventouse delivery you are less likely to need an episiotomy. As the head is delivered the cup is removed so the doctor can deliver the rest of your baby.

THINGS TO CONSIDER WHEN HAVING A VENTOUSE DELIVERY:

it can often be performed in the delivery room rather than theatre

it is more likely to leave your baby with a temporary swelling on her head (cephalhaematoma).

and more likely to cause bleeding inside your baby’s eye (retinal haemorrhage) which look like blood shot in the whites of your baby’s eyes

you may not always need an episiotomy as less space is required of the instrument being used by the doctor

you may still need a catheter inserted for up to 12 hours following the birth

you should still be able to have skin to skin with your baby

your should still be able to have delayed cord clamping

your birth partner can still cut the cord

It is important to remember that if a doctor recommends an instrumental delivery you still have the choice to question their decision and where possible take time with your midwife and birth partner to discuss what is best for you and your baby. A good acronym to remember and to use at any point of your pregnancy or labour is BRAIN.

B – what are the benefits of doing what you recommend?
R – what are the risks?
A – what are the alternatives?
I – what does my intuition tell me?
N – what happens if we do nothing?

Sometimes it’s not always possible to avoid an assisted birth but good planning and preparation during your pregnancy can help you and your partner understand the options available to you. For example having an epidural increases your chance of having as assisted delivery because:

It may slow your labour down, especially the second stage of labour when you have to start pushing, because it can be very difficult to know if you’re pushing correctly as you are numb in the area you need to focus on

It increases the risk of your baby moving into the wrong position and therefore forceps or ventouse may be required to help turn the baby into a better position

But it’s equally important to weigh up the advantages and disadvantages. No one is going to think you’ve given up or couldn’t do it if you require an instrumental delivery. And the same goes for an epidural. Your birth is about it being positive for you and I have been at many many births where women had an epidural and a ventouse delivery and it’s been wonderful, beautiful and empowering. Milli Hill founder of The Positive Birth Movement says ” A good birth doesn’t have to be a hippy dippy ‘natural’ birth, all candles, knitting midwives and placenta smoothies. Many women who have hospital births that don’t go the way they planned and end in interventions such as an instrumental delivery, report feeling positive about what happened. Milli goes on to explain why, “This is because how a woman is spoken to and treated as she has her baby is much much more important than the actual mode of delivery. Women need to feel that they have been consulted, respected and given the information they need to make free choices in the best interest of themselves and their child. This allows them to begin motherhood feeling strong, capable and mentally healthy.”

And also please be reassured that eight out of 10 women who have an assisted birth have a normal birth next time around.

Has anyone else had an assisted delivery and would like to share their experience? Any tips on coping afterwards?

My 4 year old is learning to read and write and it’s all done in phonics so we can only spell things out veeeeery slooowly in this house at the moment. Anyway yes perineum, do you know what it is and where yours is? Sounds like a stupid question right but at a recent girls supper party a friend of mine didn’t know where her perineum was, in fact she read my post about the girl with the amazing birth partner and thought that the sacrum was your perineum. Oh how we all laughed but secretly I was a little concerned. To be fair she’s not a midwife or a mother yet so she’s got lots of time to find out all about down there when the time comes. Most people cringe when they hear the word perineum, it’s a bit odd sounding isn’t? And there are lots of other names for it ones I don’t tend to use when talking to women about theirs. Basically your perineum is the piece is the muscle and tissue that lie between the bottom part of the vagina and the anus. Prior to having babies you probably don’t ever think about it but when you’re pregnant suddenly your midwife is talking about it like its public property.

The reason I’m talking about perineums is because recently at work I’ve been conducting a little audit (in my head) of all the babies I’ve delivered and if any what sort of tear did the woman sustain. Of those who had no tear or a very little graze which wouldn’t requiring stitches, I’ve asked them (where appropriate) if they did any perineal massage during pregnancy. WHAT! Massage down there during pregnancy, the last area you want to touch or even can physically reach! Yes I know it sounds all a bit ouchy but seriously my findings have been really interesting. Perineal massage isn’t something new at all, women have been practising this for centuries but only recently have I noticed more information about it on NHS leaflets, online forums and websites not to mention the amount of women who ask me ‘is it really worth doing?’ Most women worry about getting stretch marks in pregnancy and the shelves are full of various products promising to be the ‘magic’ lotion or cream to stop stretch marks during pregnancy, some range from affordable to quite frankly ridiculous and I for one used my cream religiously twice a day from about 20 weeks pregnant until 3 weeks post natal. So why such the screwed up face when I mention to women about massaging down there?

Of the women I asked following the birth of their baby, the ones who didn’t tear or only had a graze all said they did some sort or perineal massage during pregnancy. And as a midwife I could tell as the baby’s head was crowning, that the perineum had been prepared in one way or another as it stretched so beautifully (sorry but us midwives so love talking about perineums).

The best time to start perineal massage is around 34 weeks pregnant, and I would recommend using an oil such as olive oil, sweet almond oil or sunflower oil.

Start once you’ve had a bath or shower as you’ll be more relaxed and the tissue will be softer and more comfortable to touch

Prop yourself up against some pillows, you can use a mirror if this helps

Place your thumbs about 3cm inside your vagina.

Press your thumbs downward and sideways gently until you feel a tingling.

Hold this stretch for about two minutes.

Gently massage the lower part of the entrance to your vagina for about three minutes

Continue this once or twice a day, after a week you will notice an increase in flexibility and stretchiness

Some people suggest asking your partner to help with perineal massage, my husband looked at me like I was mental and to be honest I was quite happy with doing it myself. I know some of you reading this may be thinking no way am I going to do this, but seriously it might mean the difference between a second degree tear and needing stitches. So pregnant ladies next you reach for the olive oil when dressing your salad, remember it’s other qualities too.